C A S E R E P O R T EUR ANN ALLERGY CLIN IMMUNOL VOL 46, N 1, 35-37, 2014 1 Erciyes University School of Medicine, Department of Pediatric Allergy, Kayseri, Turkey 2 Intern Doctor, Erciyes University School of Medicine, Kayseri, Turkey 3 University School of Medicine, Department of Pediatrics, Kayseri, Turkey Summary Temporary tattoos, especially those that contain black dyes, have become rampant among teen- agers in recent years. Most of these tattoos, in addition to hair dyes include paraphenylenedi- amine (PPD). PPD is a well-known skin sensitizer, which causes allergic contact dermatitis. Allergic contact dermatitis skin lesions from PPD are mostly seen as erythema multiforme-like eruption, a bullous contact dermatitis or as an exudative erythema. Herein, we report on our finding on a 15 year-old adolescent female who had been unaware of being previously sensi- tized to PPD from a black henna tattoo, and angioedema-like reaction which occurred after her first exposure to hair dye. Corresponding author H Haluk Akar, MD Erciyes University School of Medicine Department of Pediatric Allergy Kayseri, Turkey E-mail: himmetakar@gmailcom phone: + 90 352 2076666/25125 fax: +90 352 4375825 KEY WORDS Paraphenylenediamine; contact sensitization; black henna tattoo; hair dye Hair dyes and temporary tattoos are a real hazard for adolescents? H. HALUK AKAR¹, S. ADATEPE², F. TAHAN¹, I. SOLMAZ³ Introduction In hairdressing, the main contact allergen is PPD, followed by its derivatives paratoluenediamine, para-aminodiphenylamine and o-nitrop-phenylenediamine (1) Although pure henna is known to be harmless, the addition of PPD, which gives a dark- er brown to black color and is sometimes used to speed up the process of hair dyeing with henna, yields what is called the black henna mixture (2-4) Herein, we will discuss our finding, re- garding a 15 year-old woman with an angioedema-like reaction that occurred after her first exposure to hair dye She came to us, unaware of having been previously sensitized to PPD by a black henna tattoo she had received a year before on her left forearm, which, at the time, had caused an allergic reaction Case report A 15 year-old adolescent female presented herself at Erciyes University Pediatric Emergency Services with severe edema in- volving the upper and lower eyelids, the forehead, scalp and face (figure 1) She consulted with our allergy department and was initially diagnosed with angioedema After using hair dye for the first time in her life, one hour later pruritus started on her scalp, forehead and face Two days after the exposure occurred, she also experienced severe edema on the scalp, forehead, up- per and lower eyelids and face We started methylprednisolone, H1 (cetirizine, hydroxyzine), H2 (ranitidine) for 5 days After the 7 days of medication, clinical improvement was observed (figure 2) She described an allergic reaction in the application area (pruritic, erythematous, edematous reaction) of a black henna tattoo she had on her left forearm one year earlier We performed a patch test including the European standard series